Case narrative

Sally will be completing her pediatric residency in 2 months and will be starting a fellowship in pediatric infectious diseases at the same medical center. Her husband, Ben, is a violinist with the local symphony orchestra. They have a 23-month-old daughter, Eve. Eve receives her medical care from a pediatric solo practitioner, Dr. Kaplan, who Sally met during her first rotation in the well baby nursery where he was her teaching attending physician.

One Friday evening, after a particularly long and difficult day at the hospital, Sally comes home and finds that her daughter seems irritable, doesn’t want to eat and might have a fever (she opts not to take Eve’s temperature since Eve usually has a temper tantrum around having her temperature taken and Sally doesn’t have the energy for a fight). Ben hasn’t noticed anything unusual and is getting ready to go off to a performance where he has a solo part. Sally decides to perform a quick exam rather than bothering Dr. Kaplan who would likely send them to the emergency room. Although Eve is not very cooperative, Sally thinks she might have a red throat and some swollen lymph nodes (although her exam was less than optimal) and decides to start an antibiotic that she happens to have sitting in the medicine cabinet.